How effective is BIRT's rehabilitation?

30 April 2009

Professor Mike Oddy summarises BIRT’s latest outcome data. Download full report (pdf 63KB).

In brain injury rehabilitation we usually work at helping people to find ways of successfully accomplishing tasks and activities such as shopping, cooking, managing their finances, organising their daily routines etc.

The ultimate goal of our rehabilitation is to enable our service users to participate in life as fully as possible and with the least assistance possible.

Outcome measures

Due to the strong emphasis on evidence based practice in recent years, BIRT has been using outcome measures designed to reflect these aims and to evaluate how successful we have been in achieving them. The main measures of outcome BIRT uses are the Supervision Rating Scale (SRS), the Neurobehavioural Rating Scale (NBRS) and the BIRT Aggression Rating Scale (BARS).

We offer a range of services and each has slightly different aims. For some service users we offer a comprehensive rehabilitation service with the aim of reintegrating them back to their homes or into the least dependent setting the individual can achieve. These service users may or may not exhibit some challenging behaviour and have the highest aims.

Targets

Our target is for 75% of service users to achieve a reduction in one or more levels of supervision on the Supervision Rating Scale (SRS). All seven of our centres offering this service achieved at least 70% and many service users achieved much more than a reduction of one level on the scale.

Our target for these service users on the Neurobehavioural Rating Scale was for a reduction of three points on this scale. This target was reached by all but one service. The service not meeting this target was one where the service users tend to come earlier after their injury and display less challenging behaviour on admission than in the other centres.

Similarly we set ourselves the target of a 20% reduction in aggression/irritability on the BIRT Aggression Rating Scale for those service users who had significant levels of aggression/irritability on admission. Once again the target was reached except in those centres where there were very few service users with challenging behaviour.

Continuing rehabilitation outcomes

In our continuing rehabilitation services service users are also working towards goals which are regularly set and reviewed, but are less likely to make major changes year after year. We therefore set our targets more conservatively. Targets set are a one point reduction on the NBRS, no change on the BARS and no more than 10% regressing on the SRS. Once again BIRT achieved these targets, often surpassing them significantly on the BARS and the NBRS.

This is just a start. We plan to use this information to direct and shape our services. The feedback it gives will help us to identify which aspects of our approach are most or least successful and allow us to direct our resources towards the most successful aspects. It also helps us to identify which groups of service users we are most successful with and those for whom we need to find improved solutions.

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